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Prostate exam guidelines debated - Ogden Clinic provided source, Standard-Examiner 08/13/2013

(Standard-Examiner) It’s only about the size of a walnut, but it can wreak havoc for men.

The prostate is a gland that sits at the base of the bladder and produces chemicals and secretions vital for reproduction. Other than that, it just causes trouble, said one local urologist.

“The prostate definitely has a function, but it is also noted for a lot of problems it causes,” said Dr. James Reynolds, a urologist at Tanner Clinic in Layton.

For starters, Reynolds said, prostate cancer is the second-leading cause of cancer deaths in American men. The gland can also enlarge as men age, squeezing the urethra and slowing the flow of urine, making it difficult for men to urinate. Prostatitis, or an inflamed or irritated prostate, can cause a burning feeling during urination. It can also cause fever and fatigue.

“The prostate grows with age and some men can run into structural problems,” Reynolds said. “There are some things we can do to help shrink it. Medications can partially shrink it, and there is a surgery to open up the urinary flow.”

Prostate cancer usually has no signs or symptoms until it’s advanced, Reynolds said. That’s why it’s critical men be screened for it.

“Prostate cancer is one of the few cancers we can screen for with a blood test,” Reynolds said. “While it won’t tell you if you have cancer, it will tell you if you have an elevated risk.”

Until recently, the American Urological Association recommended screening for prostate cancer beginning at age 40. However, recently released new guidelines recommend men with a high risk begin screening between the ages of 40 and 45, and those with a normal risk discuss screening tests with their doctor beginning at the age of 55.

Because the cancer is slow-moving, patients, along with their doctors, should weigh the risks of testing against their quality of life. Unnecessary biopsies, for example, can cause erectile dysfunction, according to the AUA.

But the new guidelines have come with plenty of controversy, Reynolds said. The screening blood test, also known as prostate specific antigen, or PSA, is useful and has saved lives.

“Prostate cancer is most common in men age 55 and up, but I have seen many cases in men in their early 40s and 50s,” Reynolds said. “But the PSA is only half of the screening. The other half is the digital exam.”

The American Cancer Society strongly supports the digital rectal exam as part of prostate screening. This exam is done with a gloved finger being inserted into the rectum to feel the prostate for any abnormal lumps.

It’s important to get both exams, Reynolds said.

“About once a month, I will see a normal PSA but feel a lump during a digital rectal exam that turns out to be cancer. If there is suspicion, a biopsy will be done to let us know whether the cancer is slow-growing and would be better to watch, or whether it’s aggressive and could end up killing.”

The National Institutes of Health estimates 238,590 new cases of prostate cancer this year, with 29,720 deaths. Prostate cancer symptoms usually don’t happen until late in the disease, but include difficulty urinating, decreased force in the stream of urine, blood in the urine or semen, swelling in the legs, bone pain and discomfort in the pelvic region.

Dr. Tyler Christensen, a urologist at Ogden Clinic, said one of the most recent revolutions in prostate cancer treatment is robot-assisted radical prostatectomy, or surgical removal of the prostate. The Da Vinci Robot, he said, is novel technology that allows prostate-cancer surgeons to remove the gland in a minimally invasive way similar to laparoscopic surgery.

“The da Vinci Robot allows 3-D visualization, enhanced magnification and precise surgical skill while maintaining the minimally invasive nature of the procedure,” he said. “Patients experience minimal discomfort and rapid recovery with robotic surgery. Robotic prostatectomy allows complete removal of the prostate cancer with minimal blood loss.”

After prostate cancer surgery, Christensen said, men live normal healthy lives with normal anticipated longevity.